Experimental measurements and Monte Carlo simulations for dosimetric evaluations of intrafraction motion for gated and ungated intensity modulated arc therapy deliveries

Respiratory gated radiation therapy allows for a smaller margin expansion for the planning target volume (PTV) to account for respiratory induced motion and is emerging as a common method to treat lung and liver tumors. We investigated the dosimetric effect of free motion and gated delivery for intensity modulated arc therapy (IMAT) with experimental measurements and Monte Carlo simulations. The impact of PTV margin and duty cycle for gated delivery is studied with Monte Carlo simulations. A motion phantom is used for this study. Two sets of contours were drawn on the mid-inspiration CT scan of this motion phantom. For each set of contours, an IMAT plan to be delivered with constant dose rate was created. The plans were generated on a CT scan of the phantom in the static condition with 3 mm PTV margin and applied to the motion phantom under four conditions: static, full superior–inferior (SI) motion (A = 1 cm, T = 4 s) and gating conditions (25% and 50% duty cycles) with full SI motion. A 6 by 15 cm piece of radiographic film was placed in the sagittal plane of the phantom and then irradiated under all measurement conditions. Film calibration was performed with a step-wedge method to convert optical density to dose. Gated IMAT delivery was first validated in 2D by comparing static film with that from gating and full motion. A previously verified simulation tool for IMRT that takes the log files from the multileaf collimator (MLC) controller and the gating system were adapted to simulate the delivered IMAT treatment for full 3D dosimetric analysis. The IMAT simulations were validated against the 2D film measurements. The resultant IMAT simulations were evaluated with dose criteria, dose-volume histograms and 3D gamma analysis. We validated gated IMAT deliveries when we compared the static film with the one from gating using 25% duty cycle using 2D gamma analysis. Within experimental and setup uncertainties, film measurements agreed with their corresponding simulated plans using 2D gamma analysis. Finally, when planning with margins designed for gating with 25% duty cycle and applying 50% or no gating during treatment, the dose differences in Dmin, D99% and D95% of the clinical target volume can be up to 27 cGy, 20 cGy and 18 cGy, respectively, for a plan with 200 cGy prescription dose. We have experimentally delivered gated IMAT with constant dose rate to a motion phantom and assessed their accuracies with film dosimetry and Monte Carlo simulations. Film dosimetry demonstrated that 25% gating and static plans are within 2%, 2 mm. The Monte Carlo simulation method was employed to generate dose delivered in 3D to a motion phantom, and the dosimetric results were reported. Since our film measurements agreed well with Monte Carlo simulations, we can reliably use this simulation tool to further study the dosimetric effects of target motion and effectiveness of gating for IMAT deliveries.